Tranexamic Acid Versus Epinephrine During Exploratory Tympanotomy

Epinephrine is a vasoconstrictor searched intensively for ptimization of the surgical field during microscopic ear and sinus surgeries with controversial results given the possible cardiovascular complication in case of systemic absorption,especially in vulnerable cardiac patients.Tranexamic acid (TXA) as an antifibrinolytic medication is used to treat or prevent excessive bleeding in significant trauma, surgery, tooth removal, or nasal bleeding, discovered by Japanese researchers. TXA, given either oral or intravenous, is a derivative of lysine amino acid; it acts reversibly on the lysine binding sites to block it on the plasminogen molecules. TXA consequently hinders the stimulation of plasminogen competitively, thus reduces its conversion into plasmin. Plasminogen is the enzyme that leads to the degradation of a fibrin clot, fibrinogen, and other plasma proteins, such as factors V and VIII. More than 95% of TXA intravenous administered dose eliminated unchanged through the urinary system. Twenty-four hours after intravenous administration of TXA has demonstrated accumulative excretion of approximately 90%, whereas only 3% is bound to plasminogen. TXA is minimally excreted in breast milk while it can freely cross the blood brain barrier and the placenta .

Inclusion criteria

• 18 - 60 years old
• ASA (I and II)
• Hb level > 10 mg/dl
• elective ear exploratory tympanotomy surgery under general anesthesia.

Exclusion criteria

• Allergy to TXA
• bleeding/coagulation disorders
• psychiatric illness
• acute and chronic renal failure
• heparin use within 48 hrs or aspirin use within seven days before surgery,
• pregnancy
• liver cirrhosis
• color blindness
• cardiac stent.